Rural Health Policy Project

Medicaid Expansion: The Facts Are In

With 34 states (including DC) now expanding Medicaid since 2014 and 17 states still refusing expansion, the ability for researchers to compare patient experiences in these disparate two groups of states has resulted in literally hundreds of high-quality studies – a “natural experiment” created by the Supreme Court’s decision to make the expansion optional.

A  recent overview article by Aaron E. Carroll from the Indiana University School of Medicine summarized much of the research. Medicaid expansion is positively impacting rural areas with more access and more patients receiving needed treatment. Other studies show overall improved access and quality of care in Medicaid expansion states and that these improvements are starting to improve people’s health.  These are just the latest in a series of studies showing positive effects of Medicaid coverage expansions. The Kaiser Family Foundation’s Robin Rudowitz and Larisa Antonisse drew on over 200 Medicaid studies included in their comprehensive literature review to conclude states expanding Medicaid showed significant improvements in coverage, access, affordability, health outcomes, economic effects and employment.

The premier health policy journal, Health Affairs, contains articles examining the effects of Medicaid expansion in nearly every issue. The July issue contains three. The August issue contains one showing Medicaid expansion means a significant increase in prescriptions for diabetes – and two others. We review research regularly at CCF as Karina Wagnerman did here, summarizing two new studies showing Medicaid’s role in promoting economic security or I did recently, collecting the key studies that show Medicaid expansion’s positive effects for parents and children.

And more studies showing an association of Medicaid expansion decisions by states with increased treatment for serious health conditions are now appearing. This one in the prestigious Journal of the American Medical Assocation found:

[A]nalysis of more than 3 million non-Medicare hospitalizations from the inpatient databases of 30 states found that expansion states had a significant reduction in the proportion of uninsured hospitalizations for major cardiovascular events within 1 year of Affordable Care Act Medicaid expansion compared with nonexpansion states.

With this much research on the positive effects of Medicaid expansion, a frequent question I field at public forums on Medicaid unsurprisingly asks this question: “The research is so extensive and clear – so why are some policymakers in non-expansion states still so resistant to considering Medicaid expansion?” While the easy answer is “political polarization,” that doesn’t tell the whole story. After all, Virginia’s recent Medicaid expansion showcased political cooperation (in the wake of a significant election) between parties in order to achieve coverage.

A broader answer recognizes the important part good research plays in policy development while acknowledging the many other factors at work, including political changes, media interest, the effect of personal stories, and the interest of politicians in responding to particular issues . Of course, political ideology obviously has an especially crucial role in the debate about Medicaid; after all, it was current House Speaker Paul Ryan who once said he had been dreaming of capping Medicaid “since you and I were drinking at a keg.” And, finally, there are independent opposition groups who seem to exist, by and large, simply to oppose Medicaid expansion.

In the continuing debate over Medicaid expansion, facts do matter. Research has had significant effects and will continue to do so.  Our research with UNC’s Rural Health Research Program last year quantified some of the enormous positive effects Medicaid has in rural areas of our country. Great work  (See Sommers and Gruber for example or Mark Hall’s amazing overview) has been done on estimating the effect of Medicaid expansion on state budgets. Several states have data that can be examined to investigate the longer-term effects of having millions of more newly-insured state residents able to pay their health care bills. A recent report by the state of Ohio documents many benefits of Medicaid coverage including an increase in employment and improvement in health for Medicaid enrollees. Studies will continue to be published every month attempting to quantify the effects of expansion on health care access, economic security and health improvement.

While any major action in health care public policy turns on multiple factors, research plays a huge role in the outcome.  And research on the effect of Medicaid expansions has overall shown significant positive effects.

Adam Searing
Adam Searing is an Associate Professor of the Practice at the Center for Children and Families

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